| NPI | 1174512669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 5202581-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 5202581-1204) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-06-04 |