| NPI | 1407143373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q5788) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD187183) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-02-27 |