| NPI | 1740628692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q6457) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL IN PROCESS) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2023-10-30 |