| NPI | 1255399820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: ID m9881) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX K0792) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: ID M-9881) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-05-05 |