| NPI | 1538733233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 7898324-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U7471) |
| 207P00000X Emergency Medicine (Licence: WY 16932A) | |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2024-06-21 |