| NPI | 1538742465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MT MED-PHYS-LIC-157848) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V1788) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2025-07-05 |