| NPI | 1679917413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX BP10047336) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q2814) |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2023-08-15 |