NPI | 1447710777 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 12793572-1204) |
Additional Taxonomies | 171000000X Military Health Care Provider (Licence: UT 12793572-1204) |
Enumeration Date | 2019-03-22 |
Last Update Date | 2022-10-18 |