| NPI | 1922040484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 31352) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 023832) |
| 207P00000X Emergency Medicine (Licence: KY C1680) | |
| 207P00000X Emergency Medicine (Licence: TX U2737) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2025-09-15 |