| NPI | 1871885996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX BP10040569) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P4889) |
| Enumeration Date | 2011-05-08 |
| Last Update Date | 2013-04-30 |