| NPI | 1366882110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R3635) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2013019643) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2019-03-14 |