| NPI | 1760123053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V1813) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ND 22382) |
| Enumeration Date | 2022-04-02 |
| Last Update Date | 2025-08-14 |