| NPI | 1164493987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 37620) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K9124) |
| 207Q00000X Family Medicine (Licence: GA 037620) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-08-23 |