| NPI | 1821083148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: TX K9298) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K9298) |
| 207V00000X Obstetrics & Gynecology (Licence: TX K9298) | |
| 207VE0102X Obstetrics & Gynecology Reproductive Endocrinology (Licence: TX K9298) | |
| 261QP2300X Clinic/Center Primary Care (Licence: TX K9298) | |
| 261QU0200X Clinic/Center Urgent Care (Licence: TX K9298) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2022-06-02 |