| NPI | 1083656433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX P5862) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 23885) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2018-08-08 |