| NPI | 1568791994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS022272) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R7410) |
| 207P00000X Emergency Medicine (Licence: CA 20A11051) | |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2023-02-13 |