| NPI | 1760440531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care (Licence: TX K9458) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K9458) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2008-09-12 |