| NPI | 1265588552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 7046201-1205) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MD T4917) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2010-09-21 |