| NPI | 1134500853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX BP10053761) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 1134500853) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2026-07-27 |