| NPI | 1851354559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME96017) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L9515) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-09-06 |