| NPI | 1649290370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R2927) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA MD00046731) |
| 207P00000X Emergency Medicine (Licence: GU M-2027) | |
| 207P00000X Emergency Medicine (Licence: IL 036112106) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2021-01-11 |