| NPI | 1740691195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S9152) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA 20A14278) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2025-11-25 |