| NPI | 1073556304 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A55341)  | 
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: CA A55341)  | 
| Enumeration Date | 2006-06-14 | 
| Last Update Date | 2023-05-23 |