| NPI | 1417149592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA intern training) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N4631) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2010-10-14 |