| NPI | 1700263043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX SO967) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA OT016479) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2019-09-17 |