| NPI | 1043294101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 8921077-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 32565020) |
| 207P00000X Emergency Medicine (Licence: NM MD2014-0811) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2022-01-17 |