| NPI | 1750341210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 149040-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 149040-1205) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2016-12-29 |