| NPI | 1174703862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N1276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 060357) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2022-02-13 |