| NPI | 1295151611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NM DO2025-0016) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: MD H84475) |
| 207P00000X Emergency Medicine (Licence: MD H84475) | |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2025-04-04 |