| NPI | 1700306834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S9628) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2019018364) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-07-19 |