| NPI | 1851664320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T1651) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102203522) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2023-06-20 |