| NPI | 1699066019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 56980) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 82996) |
| 207P00000X Emergency Medicine (Licence: TX R0807) | |
| 207P00000X Emergency Medicine (Licence: FL ME119503) | |
| 207P00000X Emergency Medicine (Licence: MN 61873) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2023-11-29 |