| NPI | 1205030038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 9434743-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-R-8166) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2016-11-14 |