| NPI | 1912004797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX L4441) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301074238) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-02-20 |