| NPI | 1659957215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2024-02679) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U2957) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2024-10-29 |