| NPI | 1962842880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q7191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301103347) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2016-06-16 |