| NPI | 1790824704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 8764362-1205) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OR MD29104) |
| 207P00000X Emergency Medicine (Licence: NM 2006-0375) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2026-04-28 |