| NPI | 1720143704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX H1534) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: TX H1534) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2010-12-01 |