| NPI | 1073573622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 29198) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX G3551) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2026-07-13 |