| NPI | 1194353318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T3715) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A187218) |
| 207P00000X Emergency Medicine (Licence: GU M-2480) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-10-02 |