| NPI | 1114217338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 55160) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P8611) |
| 207P00000X Emergency Medicine (Licence: LA 308207) | |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2021-11-09 |