| NPI | 1376837088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q5780) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 268748) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2017-02-09 |