| NPI | 1184614661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P4149) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX P4149) |
| 208D00000X General Practice (Licence: TX P4149) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2025-11-13 |