| NPI | 1457856056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A198261) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T0389) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-06-12 |