| NPI | 1154903946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PP0204X Emergency Medicine, Pediatric Emergency Medicine (Licence: UT 14271099-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ R78615) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2026-06-01 |