| NPI | 1649466459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M9143) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP1-0025744) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM a144908) | |
| Enumeration Date | 2007-09-15 |
| Last Update Date | 2015-05-17 |