| NPI | 1760648646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N9993) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 0510989) |
| 207P00000X Emergency Medicine (Licence: CA 20A15758) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2021-09-13 |