| NPI | 1962463869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX k8954) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX K8954) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2019-10-17 |