| NPI | 1184885030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N8048) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD163822) |
| 207P00000X Emergency Medicine (Licence: WA 60400513) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2013-11-05 |