| NPI | 1659375020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.021415) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0092155) |
| 207P00000X Emergency Medicine (Licence: TX J6937) | |
| 207Q00000X Family Medicine (Licence: TX J6937) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2021-06-24 |