| NPI | 1801893821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.205532) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J5046) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2016-02-23 |