| NPI | 1578907754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 302035) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S6583) |
| 207Q00000X Family Medicine (Licence: TX S6583) | |
| 207Q00000X Family Medicine (Licence: LA 302035) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2020-07-08 |