| NPI | 1275731945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N9222) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2010-00959) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2013-03-05 |