| NPI | 1912384637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12425915-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R7547) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2022-04-11 |