| NPI | 1225189988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M6011) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A 5264) |
| 207P00000X Emergency Medicine (Licence: NV 1258) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2012-04-10 |