| NPI | 1124013560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: TX J3615) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX J3615) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2011-05-19 |