| NPI | 1174541353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M5202) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX FTL 41398) |
| 207Q00000X Family Medicine (Licence: TX M5202) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-02-26 |