| NPI | 1952715500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: NC 2021-01335) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2021-01335) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2024-11-07 |