| NPI | 1003870932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX H2441) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SD 4502) |
| 207P00000X Emergency Medicine (Licence: OK 16118) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2023-03-07 |