| NPI | 1154459584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX k3654) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX k3654) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2010-01-11 |