| NPI | 1366422792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX H1582) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX H1582) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2007-07-08 |