| NPI | 1285633065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: ID M4528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M4528) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2018-04-04 |