| NPI | 1619611191 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V8954) | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 1619611191) | 
| Enumeration Date | 2022-04-21 | 
| Last Update Date | 2025-10-28 |