| NPI | 1790962835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6869) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 5101016760) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2012-10-18 |