| NPI | 1962440073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX K0790) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 14468R) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-09-08 |