| NPI | 1518978121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX L1043) |
| Additional Taxonomies | 202K00000X (Licence: TX L1043) |
| 207P00000X Emergency Medicine (Licence: TX L1043) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX L1043) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2022-03-03 |