| NPI | 1063480465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101040968) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101040968) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2007-07-08 |