| NPI | 1053519645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P1852) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD60915016) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2024-08-01 |