| NPI | 1215686860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V8357) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 06339) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2026-04-21 |