| NPI | 1255693719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7725) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10042763) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2013-12-16 |