| NPI | 1649259193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX E4808) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX E4808) |
| 207Q00000X Family Medicine (Licence: TX E4808) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2011-03-31 |