| NPI | 1649242231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WA MD00043172) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA MD00043172) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2024-03-14 |