| NPI | 1346655669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX R4626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX R4626) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2025-02-13 |