| NPI | 1902242399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: ID O-1146) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR DO188047) |
| 207P00000X Emergency Medicine (Licence: TX Q5864) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2021-05-31 |