| NPI | 1073755773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P4430) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102203078) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: TX P4430) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TX P4430) | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2014-05-29 |