| NPI | 1568401701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX G2689) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX G2689) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-03-05 |