| NPI | 1588629893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N5328) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35067442p) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2025-07-22 |