| NPI | 1891711677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M0863) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MD420172) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2018-07-05 |