| NPI | 1689315475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 14206492-1204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 24746) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-09-15 |