| NPI | 1770802761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA DO.000288) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q1370) |
| 207P00000X Emergency Medicine (Licence: WI 5762) | |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2018-04-11 |