| NPI | 1467793034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX P8253) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX BP10042479) |
| 207P00000X Emergency Medicine (Licence: TX P8253) | |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2015-01-02 |