| NPI | 1245596337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q9672) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 29105) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2016-09-30 |