| NPI | 1215130505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX m7697) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 16492) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2008-07-02 |