| NPI | 1316935356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX L6232) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX l6232) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TX L6232) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-12-22 |