| 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 | 2025-05-28 |