| NPI | 1578505657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101247009) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L0570) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-06-30 |