| NPI | 1184073835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX BP10056885) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 27170) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2025-05-02 |