| NPI | 1558638361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX p1970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX p1970) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2015-03-10 |