| NPI | 1013081801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: UT 165309-1205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 165309-1205) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-02-07 |