| NPI | 1174629299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: LA md020779) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA md020779) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2009-12-01 |