| NPI | 1720279748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q5800) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA PGY1.1-EKL) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2024-09-16 |