| NPI | 1154647113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P6924) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 308) |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2018-11-02 |