| NPI | 1205220324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME136902) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME136902) |
| 207R00000X Internal Medicine (Licence: FL TRN20757) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-03-05 |