| NPI | 1104080514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A135072) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P5885) |
| 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: CA A135072) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2016-02-26 |