| NPI | 1114075819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD28129) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 76679) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: OR MD28129) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-02-18 |