| NPI | 1114960473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX L8691) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L8691) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-09-17 |