| NPI | 1194993881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NY 247484) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 247484) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: NY 247484) | |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2013-03-07 |