| NPI | 1295362366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: HI MD-23382-0) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI MD-23382-0) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2023-08-22 |