| NPI | 1225133085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX L9162) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: LA 200791) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-03-17 |