| NPI | 1780612481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V4664) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 38853) |
| 207R00000X Internal Medicine (Licence: TN 43746) | |
| 207P00000X Emergency Medicine (Licence: AR E-13275) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2025-08-25 |