| NPI | 1124095591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MI 4301071310) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301071310) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2012-07-10 |