| NPI | 1407084296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q0966) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 30556) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-01-13 |