| NPI | 1508396433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101272123) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-06-30 |