| NPI | 1710984315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX D9634) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: WY 5551A) |
| 207Q00000X Family Medicine (Licence: WY 5551A) | |
| 207P00000X Emergency Medicine (Licence: WY 5551A) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2016-06-13 |