| NPI | 1932464609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 53904) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 565340) |
| 207P00000X Emergency Medicine (Licence: TX P8098) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2020-04-21 |