| NPI | 1457858367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S5872) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 325069) |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2021-08-12 |