| NPI | 1770232274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W6418) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 336418) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-05-24 |