| NPI | 1619197043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA C56028) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R4582) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-08-27 |