| NPI | 1851886113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T5981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT018454) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2022-03-23 |