| NPI | 1811379456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R1369) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10053755) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2017-05-17 |