| NPI | 1922494905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KS 0542187) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R6924) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2022-12-19 |