| NPI | 1518318732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U3972) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19764) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2023-08-07 |