| NPI | 1588980825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA 205036) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AZ 58492) |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2019-11-08 |