| NPI | 1043304819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 6597798-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 49023-020) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-10 |