| NPI | 1316633365 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX BP10083798) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V9581) | 
| Enumeration Date | 2023-04-13 | 
| Last Update Date | 2025-07-18 |