| NPI | 1578764205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N5690) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102202169) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2010-11-04 |