| NPI | 1801390158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T5276) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 84220) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2022-06-30 |