| NPI | 1558924274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A181508) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 208D00000X General Practice (Licence: IN 01084351A) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2025-04-24 |