| NPI | 1265474183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R1315) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-086174) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2021-07-29 |