| NPI | 1790045359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0102205995) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102205995) |
| 286500000X Military Hospital | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2021-06-15 |