| NPI | 1760619027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX P9585) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2012-01485) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2026-09-08 |