| NPI | 1194341800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 13882174-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT020119) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2024-04-05 |