| NPI | 1720282452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N6647) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 142229) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2025-11-10 |