| NPI | 1801153317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R2919) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101264430) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2025-03-07 |