| NPI | 1023322328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q5224) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2010020865) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2016-03-31 |