| NPI | 1487688552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5241109-1205) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: UT 5241109) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-10-07 |