| NPI | 1245387059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P0835) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 14552) |
| 207P00000X Emergency Medicine (Licence: GA 64107) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2022-01-25 |