| NPI | 1336307081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX p1109) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 532734) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2020-06-01 |