| NPI | 1568753481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S5109) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015000034) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2023-01-06 |