| NPI | 1962646703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N5609) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM MD2009-0081) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2011-08-23 |