| NPI | 1225376072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R0287) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 28298) |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2016-10-31 |