| NPI | 1306831169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: PA MD015683E) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD015683E) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2015-07-31 |