| NPI | 1215678040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD224072) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U7472) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2025-07-04 |