| NPI | 1134184716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K5370) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX K5370) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2019-06-06 |