| NPI | 1831517424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME131295) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T6500) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2026-01-10 |