| NPI | 1821354598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q2072) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 270821) |
| Enumeration Date | 2012-04-07 |
| Last Update Date | 2023-10-31 |