| NPI | 1609135904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: TX BP10042752) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10042752) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2024-06-26 |