| NPI | 1891710471 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX FTL 42805) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 220874) | 
| Enumeration Date | 2006-07-13 | 
| Last Update Date | 2010-06-15 |