| NPI | 1962962399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T0510) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX T0510) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2022-07-27 |