| NPI | 1972563237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6123) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101236525) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2018-12-12 |