| NPI | 1528760600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W3537) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TC103) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2026-06-15 |