| NPI | 1548464696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6856) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL TRN11660) |
| 207P00000X Emergency Medicine (Licence: GA 063312) | |
| 207P00000X Emergency Medicine (Licence: FL ME105634) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2013-01-28 |