| NPI | 1568754729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R5939) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207P00000X Emergency Medicine (Licence: MN 65440) | |
| 208D00000X General Practice (Licence: MN 65440) | |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2026-08-20 |