| NPI | 1659508232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2020-0390) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P1017) |
| 207P00000X Emergency Medicine (Licence: CT 047773) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2020-06-11 |