| NPI | 1336721885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U9633) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC PERA-DQXK4L) |
| Enumeration Date | 2021-04-24 |
| Last Update Date | 2024-06-25 |