| NPI | 1518464643 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-96286) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 11420196-1205) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2021-11-11 |