| NPI | 1649913682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101286082) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U7675) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-09-02 |