| NPI | 1154388601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A9506) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A9506) |
| 207Q00000X Family Medicine (Licence: TX L9392) | |
| 207P00000X Emergency Medicine (Licence: TX L9392) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-11-06 |