| NPI | 1417277518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P3113) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TX BP10037422) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2013-08-19 |