| NPI | 1124552807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A157713) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2023-07-30 |