| NPI | 1538505565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WY TL3611) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R3122) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2025-02-20 |