| NPI | 1588980825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: AZ 58492) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 58492) |
| 208D00000X General Practice (Licence: AZ 58492) | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2025-11-24 |