| NPI | 1821166331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N0593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2005-0424) |
| 207P00000X Emergency Medicine (Licence: CA C149057) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2023-06-24 |