| NPI | 1811921000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M0203) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX m0203) |
| 207Q00000X Family Medicine (Licence: TX M0203) | |
| 207R00000X Internal Medicine (Licence: TX M0203) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-01-06 |