| NPI | 1053013656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME179176) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX W4517) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-08-24 |