| NPI | 1700845195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OH 35.150633) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX S7471) |
| 207P00000X Emergency Medicine (Licence: GA 058258) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX S7471) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: GA 058258) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2024-09-24 |