| NPI | 1780118505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 11587743-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 290618) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-07-11 |