| NPI | 1922427368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U9935) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA A170060) |
| 207P00000X Emergency Medicine (Licence: FL ME173634) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2025-09-12 |