| NPI | 1891084448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R3843) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101252570) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2024-07-19 |