| NPI | 1538780432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A196296) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2024-11-15 |