| NPI | 1942527015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P8198) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301096029) |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2016-04-27 |