| NPI | 1689000465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U9456) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 289711) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2026-08-06 |