| NPI | 1043364797 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 7834A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 6447817-1205) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-02-10 |