| NPI | 1245593573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5257) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101020097) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-09-16 |