| NPI | 1730684564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T6088) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 309068) |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2022-08-03 |