| NPI | 1659717734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q8216) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 191711) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2018-08-27 |