| NPI | 1669963823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME180878) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101267887) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2026-07-09 |