| NPI | 1659528594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 23500) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P6326) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2022-02-25 |