| NPI | 1619231875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 5101020034) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R3039) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2026-04-09 |