| NPI | 1740233600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX L3040) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L3040) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-01-07 |