| NPI | 1255592432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N8317) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2010-0820) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2011-07-26 |