| NPI | 1811525371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME158932) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX V6850) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-04-19 |