| NPI | 1972528974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX H0674) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H0674) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-07-20 |