| NPI | 1336470426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q0214) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018508) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2020-03-23 |