| NPI | 1134149016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX P3121) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX P3121) |
| 208600000X Surgery (Licence: MS 19286) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2015-10-13 |