| NPI | 1972763621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA 20A14703) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2017-07-16 |