| NPI | 1225665540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2023-01458) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX 708377) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2023-10-31 |