| NPI | 1790355527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V1262) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2021023164) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2025-04-16 |