| NPI | 1194395863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V5265) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 7669) |
| 207P00000X Emergency Medicine (Licence: OK 0475R) | |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2025-09-04 |