| NPI | 1770798563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OT011248) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P2863) |
| 208D00000X General Practice (Licence: NE 2008) | |
| 207P00000X Emergency Medicine (Licence: NE 2008) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2026-01-20 |