| NPI | 1710181458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P3445) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 17159) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2023-02-08 |