| NPI | 1760830343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2021-01323) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R4970) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2021-09-23 |