| NPI | 1942734413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S8000) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IL 00000) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2021-01-11 |