| NPI | 1063838159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A155768) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA A155768) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2026-01-23 |