| NPI | 1770167355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W7297) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 48759) |
| 207P00000X Emergency Medicine (Licence: TX 48432) | |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2026-07-02 |