| NPI | 1962580654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12515948-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD26697) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-09-28 |