| NPI | 1942864590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2022-01191) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10066795) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2022-07-02 |