| NPI | 1750669925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P9157) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301099381) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2024-09-12 |