| NPI | 1912955899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J7606) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 321114) |
| 207R00000X Internal Medicine (Licence: LA 321114) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-04-19 |