| NPI | 1922008101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX M1013) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Temporary) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2014-09-18 |