| NPI | 1194721076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 012753) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: SC 012753) |
| 207Q00000X Family Medicine (Licence: SC 012753) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-03-28 |