| NPI | 1073530960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 307895) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L5645) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2019-05-17 |