| NPI | 1578597647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 180675-1205) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 180675) |
| 208600000X Surgery (Licence: UT 180675-8905) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-10-29 |