| NPI | 1801182845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q5417) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT199990) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2021-09-11 |