| NPI | 1255658027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7079) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R2430) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2014-05-28 |