| NPI | 1154755452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12724599-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME144556) |
| 207P00000X Emergency Medicine (Licence: MN 12724599-1205) | |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2022-06-28 |