| NPI | 1356900740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101287417) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T6317) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2026-04-09 |