| NPI | 1154680973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q7997) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101257621) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2024-09-12 |