| NPI | 1720247505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N5151) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: TX N5151) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2026-03-13 |