| NPI | 1558853655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX 2063) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 010019) |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2021-07-29 |