| NPI | 1457761819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R1699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 76421) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2018-03-17 |