| NPI | 1679860803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q4747) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OTO14341) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2016-01-11 |