| NPI | 1912023169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q8119) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA GETP.200934) |
| 152W00000X Optometrist (Licence: LA 1663-697T) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-11-09 |