| NPI | 1790728731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX W5549) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NH 19325) |
| 207P00000X Emergency Medicine (Licence: MA 210707) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2026-09-16 |