| NPI | 1134101843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: AZ 50799) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 50799) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2023-06-20 |