| NPI | 1154318152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AR C5964) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: AR C5964) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2010-11-01 |