| NPI | 1093166480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 186415) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207P00000X Emergency Medicine (Licence: AZ 54137) | |
| 207P00000X Emergency Medicine (Licence: NC 2020-02958) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-08-14 |