| NPI | 1063739308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-45767) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P8422) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2025-02-10 |