| NPI | 1225771389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 61016) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U9063) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-10-07 |