| NPI | 1619962362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U0802) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 4373) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2024-06-27 |