| NPI | 1720087422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX G5520MD) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G5520) |
| 207P00000X Emergency Medicine (Licence: NM 95-130) | |
| 207P00000X Emergency Medicine (Licence: WA MD00048129) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2011-12-06 |