| NPI | 1902149123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S6801) |
| Additional Taxonomies | 207PS0010X Emergency Medicine, Sports Medicine (Licence: TN 56330) |
| 207P00000X Emergency Medicine (Licence: TN 56330) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: TX S6801) | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2026-07-07 |