| NPI | 1205887361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX K7292) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME92697) |
| 207Q00000X Family Medicine (Licence: TX K7292) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2022-08-18 |