| NPI | 1972640472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M6671) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD T4085) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2018-07-23 |