| NPI | 1871925776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U9178) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL OS12926) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2026-07-22 |