| NPI | 1255371159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 229341) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX R7930) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2024-09-12 |