| NPI | 1740280999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX G0607) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX G0607) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2023-01-30 |