| NPI | 1215516976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V6720) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 178237) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2026-03-06 |