| NPI | 1295151611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: MD H84475) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MD H84475) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2021-03-08 |