| NPI | 1770996720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD179760) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R1242) |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2022-03-07 |