| NPI | 1558771329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q6149) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10050373) |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2016-08-02 |