| NPI | 1407805492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD60193724) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 34232) |
| 207P00000X Emergency Medicine (Licence: TX P6639) | |
| 207P00000X Emergency Medicine (Licence: CO 39160) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-12-01 |