| NPI | 1831509157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX R4521) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2018-05-19 |