| NPI | 1033677455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W0682) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PR 37301-R) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2025-10-31 |