| NPI | 1598957003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N1873) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD201944) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2022-01-14 |