| NPI | 1053430975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX E8262) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX E8262) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2019-01-07 |