| NPI | 1902164569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q4046) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101255037) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2024-06-14 |