| NPI | 1760453898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX p3634) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101234597) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2024-03-05 |