| NPI | 1336266170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T2891) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101241377) |
| 207P00000X Emergency Medicine (Licence: TN MD0000054851) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2023-03-20 |