| NPI | 1811923006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U1356) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA04598) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-08-07 |