| NPI | 1952756546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5702) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP129) |
| 207P00000X Emergency Medicine (Licence: WY 12192A) | |
| 207P00000X Emergency Medicine (Licence: WY TL5750) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2024-04-25 |