| NPI | 1487940482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P4296) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P4296) |
| 207P00000X Emergency Medicine (Licence: OK 5309) | |
| 207R00000X Internal Medicine (Licence: OK 5309) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2020-06-25 |