| NPI | 1669797619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N-5179) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR MD154029) |
| 207P00000X Emergency Medicine (Licence: OR MD154029) | |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2016-09-12 |