| NPI | 1215255633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P9695) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.20529) |
| Enumeration Date | 2010-05-10 |
| Last Update Date | 2015-10-29 |