| NPI | 1679602478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N1434) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 24602) |
| 207P00000X Emergency Medicine (Licence: LA MD.205596) | |
| 207Q00000X Family Medicine (Licence: LA MD.205596) | |
| 207Q00000X Family Medicine (Licence: OK 24602) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207Q00000X Family Medicine (Licence: TX N1434) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2025-12-23 |