| NPI | 1154597854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A101283) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 260961-1) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NY 260961-1) | |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2012-03-30 |