| NPI | 1871708545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N8479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT188889) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2012-07-06 |