| NPI | 1609831239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: TX H2659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX H2659) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-08 |