| NPI | 1275996696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM a-2419-20) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NM a-2419-20) |
| 208D00000X General Practice (Licence: MO 2016017267) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2024-04-04 |