| NPI | 1730288721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX F4553) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX F4553) |
| 207Q00000X Family Medicine (Licence: TX F4553) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2012-01-17 |