| NPI | 1760916209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WI 74168) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX R9604) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-12-03 |