| NPI | 1164985909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T5412) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME154115) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2022-11-14 |