| NPI | 1316395403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S1905) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME151769) |
| Enumeration Date | 2016-05-30 |
| Last Update Date | 2024-05-21 |