| NPI | 1881915254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P6172) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2012-01873) |
| Enumeration Date | 2010-06-19 |
| Last Update Date | 2015-12-07 |