| NPI | 1588313894 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 14135416-1205) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NV 27774) | 
| Enumeration Date | 2022-03-22 | 
| Last Update Date | 2025-09-17 |