| NPI | 1770530149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M4475) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 20050000794) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2011-02-02 |