| NPI | 1164448429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX n9512) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 48597) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-02-01 |