| NPI | 1821259797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P4441) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 64030) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2022-10-07 |