| NPI | 1871913947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 21320) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R1833) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2021-10-28 |