| NPI | 1851595656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N1073) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 244516) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2011-07-05 |