| NPI | 1770590531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX J0811) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 24830) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-06-06 |