| NPI | 1740207349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AL 15721) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F4643) |
| 207P00000X Emergency Medicine (Licence: WI 44855-020) | |
| 207P00000X Emergency Medicine (Licence: GA 86572) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-10-14 |