| NPI | 1053355990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA OS007155L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS007155L) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA 05007155L) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-02-01 |