| NPI | 1164476313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME99486) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA a79311) |
| 207P00000X Emergency Medicine (Licence: FL ME99486) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-04-25 |