| NPI | 1497191621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R1132) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020469) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2018-03-23 |