| NPI | 1578524633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 162190-1205) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: UT 162190-1205) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2010-04-21 |