| NPI | 1518259258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q9876) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.207232) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2017-02-20 |