| NPI | 1407288756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R6259) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 31793) |
| 207P00000X Emergency Medicine (Licence: CA 137903) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2026-06-27 |