| NPI | 1114978137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 8159967-8017) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX G5423) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-02-04 |