| NPI | 1487852281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 76839741205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 8555A) |
| 207P00000X Emergency Medicine (Licence: KY TP827) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2011-07-07 |