| NPI | 1962909887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T7586) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV DO2958) |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2022-09-23 |