| NPI | 1902127475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX p9862) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101018830) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2023-08-21 |