| NPI | 1417992744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N9942) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35070916R) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2016-02-29 |