| NPI | 1346283892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MO 2002019238) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2002019238) |
| 207Q00000X Family Medicine (Licence: MO 2002019238) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-03-28 |