| NPI | 1316004484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME48214) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME48214) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME48214) | |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2021-03-29 |