| NPI | 1518952142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: GA 051994) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX m6319) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2007-07-23 |