| NPI | 1942292115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 33931) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 200201262) |
| 207P00000X Emergency Medicine (Licence: TX J0165) | |
| 207P00000X Emergency Medicine (Licence: TN 46920) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2022-01-05 |