NPI | 1861889081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 0063031) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2015-04-26 |
Last Update Date | 2020-01-10 |