| NPI | 1063753390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NY 288755) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T2123) |
| Enumeration Date | 2013-03-12 |
| Last Update Date | 2021-10-19 |