| 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 |