| NPI | 1770533168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K7902) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: TX K7902) |
| 207P00000X Emergency Medicine (Licence: TX K7902) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-10-09 |