| NPI | 1669851903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2018-02287) |
| Additional Taxonomies | 286500000X Military Hospital (Licence: TX 390200000X) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2019-11-22 |