| NPI | 1720067432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N3274) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS7832) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2016-01-21 |