| NPI | 1568025013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A184255) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GU MD-P-2024-006) |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2024-11-20 |