| NPI | 1124321765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM 83-238) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J4893) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2010-12-20 |