| NPI | 1730386343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N5344) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: PA MT191487) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2025-07-26 |