| NPI | 1134650062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX S0408) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S0408) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2026-05-22 |