| NPI | 1619136918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N4317) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 38635) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2011-03-30 |