| NPI | 1518599034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U8604) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101273657) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2026-03-11 |