| NPI | 1457617979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MD D0101086) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T2155) |
| 207P00000X Emergency Medicine (Licence: MA 274377) | |
| 207P00000X Emergency Medicine (Licence: TX BP10052946) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2026-02-04 |