| NPI | 1356368815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 2003013341) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN DO0000001466) |
| 207P00000X Emergency Medicine (Licence: OK 3806) | |
| 207P00000X Emergency Medicine (Licence: TX P2241) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-01-16 |