| NPI | 1104864362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 04-25705) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX J3128) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-02-12 |