| NPI | 1699768119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX F9192) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F9192) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2021-03-31 |