| NPI | 1992969711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6078) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 251621) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2022-07-01 |