| NPI | 1770508137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX K5852) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 07709R) |
| 207P00000X Emergency Medicine (Licence: OH 35.057012) | |
| 207P00000X Emergency Medicine (Licence: OK 16437) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2007-07-08 |