| NPI | 1831658806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 178163) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-05-01 |