| NPI | 1134326366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI MD18283) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI MD18283) |
| 208000000X Pediatrics (Licence: HI MD18283) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-04-05 |