| NPI | 1588124275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W4551) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 10351) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2026-03-19 |