| NPI | 1629573290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME149795) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T1816) |
| 207P00000X Emergency Medicine (Licence: WI 76353) | |
| 207P00000X Emergency Medicine (Licence: GA 89400) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-02-24 |