| NPI | 1609339209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX AP141064) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F01191104) |
| 363L00000X Nurse Practitioner (Licence: TX AP141064) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2023-07-11 |