| NPI | 1518347152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R6802) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL38314) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2018-08-31 |