| NPI | 1457519266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q0010) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2014-06-12 |