| NPI | 1154989812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T6352) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2021000609) |
| 207P00000X Emergency Medicine (Licence: CA 20A19240) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2025-11-05 |