| NPI | 1619325842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T8755) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 83927) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2025-06-13 |