| NPI | 1477904704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S7587) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022787) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2021-06-17 |