| NPI | 1003947961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N3571) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL 29020) |
| 207P00000X Emergency Medicine (Licence: TX TEMP MED LICENSE) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2010-09-22 |