| NPI | 1417319799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12115660-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 19103) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2021-02-24 |