| NPI | 1164950176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 11684512-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2020-0548) |
| 207P00000X Emergency Medicine (Licence: TX BP10061473) | |
| 207P00000X Emergency Medicine (Licence: TX S2489) | |
| Enumeration Date | 2017-06-03 |
| Last Update Date | 2020-10-05 |