| NPI | 1588013858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD214759) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2023-07-05 |