| 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 |