| NPI | 1902893183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N8121) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101236229) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2025-10-17 |