| NPI | 1932584612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A144011) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2022-05-17 |