| NPI | 1164439675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A667920) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: CA A667920) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2008-01-14 |