| NPI | 1134149610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 174662-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 174662-1205) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2026-02-24 |