| NPI | 1598345209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W6234) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2024014095) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2026-07-23 |