| NPI | 1013918770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J6356) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00047350) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2016-10-05 |