| NPI | 1619968724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME74751) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2011-0668) |
| 207P00000X Emergency Medicine (Licence: IN 01046121A) | |
| 207P00000X Emergency Medicine (Licence: TX N9403) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-10-03 |