| NPI | 1891172938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R0583) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 309777) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2018-09-26 |