| NPI | 1730159823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX G2964) |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX G2964) |
| 208D00000X General Practice (Licence: TX G2964) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2017-02-22 |