| NPI | 1780970954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MI 4301098982) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q0961) |
| Enumeration Date | 2011-06-25 |
| Last Update Date | 2026-01-26 |