| NPI | 1790078145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P7073) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10039807) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2015-01-26 |