| NPI | 1558655126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q1039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP100040018) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2019-01-10 |