| NPI | 1487101259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX S4891) |
| Additional Taxonomies | 208VP0000X (Licence: PR 24332) |
| 207P00000X Emergency Medicine (Licence: TX S4891) | |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2025-12-05 |