| NPI | 1659313708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX 9699) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 9699) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2009-02-10 |