| NPI | 1477116846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX U4468) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 91679) |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: GA 91679) | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2023-07-31 |