| NPI | 1104327527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T1029) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 23517) |
| 208D00000X General Practice (Licence: NE 2090) | |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2025-05-28 |