| NPI | 1871889311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101273494) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 302147) |
| 207P00000X Emergency Medicine (Licence: NV 17393) | |
| 207P00000X Emergency Medicine (Licence: TX R4519) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2022-11-01 |