| NPI | 1174815021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY 10598A) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: DC MD043197) |
| 207P00000X Emergency Medicine (Licence: TX R5511) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2023-02-20 |