| NPI | 1336896166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V8977) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101280164) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2025-07-10 |