| NPI | 1194245662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A18937) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA 1194245662) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2021-08-06 |