| NPI | 1508112509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX Q0569) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX BP10045077) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2025-07-26 |