| NPI | 1902191844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PS0010X Emergency Medicine, Sports Medicine (Licence: TX Q6465) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX Q6465) |
| 207P00000X Emergency Medicine (Licence: NY 276183) | |
| 207R00000X Internal Medicine (Licence: TX BP1-00040918) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2023-02-07 |