| NPI | 1164619474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 6353252-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 6353252-8905) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2007-10-01 |