| NPI | 1265060537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 331165) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T9926) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-01-11 |