| NPI | 1780738500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V8420) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101008474) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-05-22 |