| NPI | 1710272547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 138053) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME120754) |
| 207P00000X Emergency Medicine (Licence: TX TRN15976) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2025-02-12 |