| NPI | 1619627668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V8360) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP802) |
| 207P00000X Emergency Medicine (Licence: MO 2025032128) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-03-25 |