| NPI | 1902815350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM MD2015-0007) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T2885) |
| 207P00000X Emergency Medicine (Licence: CA A81082) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2026-03-06 |