| NPI | 1164817946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S6159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6159) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-09-21 |