| NPI | 1558894832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD210400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R9949) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2025-12-12 |