| NPI | 1578858171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 10495615-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MN 55346) |
| 207P00000X Emergency Medicine (Licence: TX P9892) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2020-02-10 |