| NPI | 1881221521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 80838) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX U5407) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-08-20 |