| NPI | 1780432237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W8884) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM DO2026-0153) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10090503) | |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2026-10-21 |