| NPI | 1922452200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S2477) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 5101022486) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2025-04-28 |