| NPI | 1255759684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R7498) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2014020658) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2018-08-15 |