| NPI | 1912158635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NV DO1418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX H4172) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2024-10-29 |