| NPI | 1700262524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 11262080-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WY 12196A) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2020-07-06 |