| NPI | 1508027020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P1292) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101017607) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2013-12-10 |