| NPI | 1790985927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 324393) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N9507) |
| 207P00000X Emergency Medicine (Licence: PA MT191161) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2021-09-28 |