| NPI | 1376651687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX F7882) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 11416) |
| 207P00000X Emergency Medicine (Licence: CA A33231) | |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2007-07-08 |