| NPI | 1033428263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W0104) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 23014322) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2025-09-28 |