| NPI | 1174888242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: OH 35.143521) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NM MD2023-1066) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-09-06 |