| NPI | 1235131897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R6P79) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R6P79) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: MO R6P79) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2018-10-05 |