| NPI | 1023640547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2025-1259) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V5594) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2026-02-03 |