| NPI | 1326025396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: ID 0-102) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: ID 0-102) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-07-31 |