| NPI | 1578552535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N4878) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 045156) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2012-12-17 |