| NPI | 1265472419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX K9155) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX K9155) |
| 207Q00000X Family Medicine (Licence: TX K9155) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-05-18 |