| NPI | 1417921479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J6440) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX j6440) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-05-20 |