| NPI | 1124302179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P6920) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301097148) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2014-01-23 |