| NPI | 1760922025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX T4043) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OK 390200000) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2026-02-05 |