| NPI | 1881980704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX T7327) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T7323) |
| 207P00000X Emergency Medicine (Licence: CA 13342) | |
| 208D00000X General Practice (Licence: CA 13342) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-11-26 |