| NPI | 1801878095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 164124-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 164124-1205) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-07-08 |