| NPI | 1306983093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 23828) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2104) |
| 207P00000X Emergency Medicine (Licence: TX M4977) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2018-03-09 |