| NPI | 1518101518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7049) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV DO1667) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2018-04-30 |