| NPI | 1245610872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 57.258496) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 29456) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2025-08-07 |