| NPI | 1336566579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R8597) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 312511) |
| 207P00000X Emergency Medicine (Licence: WA 60726358) | |
| 207P00000X Emergency Medicine (Licence: CA A148543) | |
| 207P00000X Emergency Medicine (Licence: NV 16944) | |
| 207P00000X Emergency Medicine (Licence: OR 181553) | |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2019-07-19 |