| NPI | 1376560979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX L0601) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101227520) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-02-18 |