| NPI | 1790911139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AR E7037) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AR E7037) |
| 207Q00000X Family Medicine (Licence: AR E7037) | |
| 207P00000X Emergency Medicine (Licence: TX Q2467) | |
| 207Q00000X Family Medicine (Licence: TX Q2467) | |
| 208D00000X General Practice (Licence: TX Q2467) | |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2015-01-16 |