| NPI | 1043389141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX J5312) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J5312) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2023-11-07 |