| 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 | 2025-08-18 |