| NPI | 1407829310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N0443) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME0087623) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2010-11-18 |