| NPI | 1316159700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N4290) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME97332) |
| 207P00000X Emergency Medicine (Licence: TN 43639) | |
| 207P00000X Emergency Medicine (Licence: LA 09467R) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2012-10-02 |