| NPI | 1235220591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q6250) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE TEP5516) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-12-28 |