| NPI | 1609255728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101280403) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R5527) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2025-12-17 |