| NPI | 1306855002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101240947) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NC NC 96-01187) |
| 207P00000X Emergency Medicine (Licence: NC NC 96-01187) | |
| 207P00000X Emergency Medicine (Licence: SC 29102) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-08-11 |