| NPI | 1487004099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU M-2256) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-05-05 |