| NPI | 1972528073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX E0401) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX E0401) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX E0401) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-07-05 |