| NPI | 1194091462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q2452) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 252800) |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2023-02-03 |