| NPI | 1376805069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX B0099522973) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R6801) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2024-09-04 |