| NPI | 1811671043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC LL92367) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC MD92367) |
| 207P00000X Emergency Medicine (Licence: TX W5212) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 701710) | |
| Enumeration Date | 2023-06-08 |
| Last Update Date | 2026-05-23 |