| NPI | 1215142914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX M7323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102201740) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-01-26 |