| NPI | 1255674883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T6389) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 283558-1) |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2022-11-21 |