| NPI | 1790340487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102206508) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U7152) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2025-10-07 |