| NPI | 1285112672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: PR 22845) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 15649) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2023-02-25 |