| NPI | 1699754846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N4525) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N4525) |
| 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: TX N4525) | |
| Enumeration Date | 2006-01-15 |
| Last Update Date | 2015-07-17 |