| NPI | 1861607962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301085611) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX M9370) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2010-09-11 |