| NPI | 1114061504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A97723) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX S4726) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2020-11-04 |