| NPI | 1891733911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX E7522) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX E7522) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2011-06-01 |