| NPI | 1073965059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 70176) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2022-08-12 |