| NPI | 1457745242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A180204) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2024-11-10 |