| NPI | 1437122488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101240684) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116014055) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2022-10-27 |