| NPI | 1780939991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 54789) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P8649) |
| 202K00000X Phlebology (Licence: TX P8649) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2025-12-18 |