| NPI | 1235714064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MS 33627) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MS 33627) |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2024-11-16 |