| NPI | 1982221040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX V1913) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 76140-20) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2025-02-12 |