| NPI | 1205122660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q9709) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT200263) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2020-07-02 |