| NPI | 1821475948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T1090) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2023012499) |
| 207P00000X Emergency Medicine (Licence: CT 62302) | |
| 207P00000X Emergency Medicine (Licence: OH 35.132999) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2023-09-06 |