| NPI | 1942940291 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 14207022-1204) | 
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 14207022-1204) | 
| Enumeration Date | 2022-04-01 | 
| Last Update Date | 2025-06-14 |