| NPI | 1316130487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N9563) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017510) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2012-04-10 |