| NPI | 1376660118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M9022) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101016084) |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2009-08-03 |