| NPI | 1255626438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 71770) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q1035) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2019-10-21 |