| NPI | 1649263518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K2254) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K2254) |
| 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: TX K2254) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2022-02-17 |