| NPI | 1609866425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J5622) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BJ5622) |
| 208D00000X General Practice (Licence: TX J5622) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2018-03-29 |