| NPI | 1255998076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV OP61075581) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V9565) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-07-01 |