| NPI | 1134151624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N0590) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 19019) |
| 207Q00000X Family Medicine (Licence: TX N0590) | |
| 207Q00000X Family Medicine (Licence: MS 19019) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-07-21 |