| NPI | 1912931163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U6582) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: GA 058222) |
| 207P00000X Emergency Medicine (Licence: GA 058222) | |
| 207Q00000X Family Medicine (Licence: GA 06-041) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-04-29 |