| NPI | 1659723914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12954389-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A16698) |
| 207P00000X Emergency Medicine (Licence: OR DO0207753) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2022-09-26 |