| NPI | 1962558304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N2839) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101240821) |
| 207P00000X Emergency Medicine (Licence: NC 2007-00434) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NC 2007-00434) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-03-10 |