| NPI | 1265458111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX K8206) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A066961) |
| 207P00000X Emergency Medicine (Licence: RI MD09556) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-06-27 |