| NPI | 1447218821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX N1002) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: SC 27731) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-09-26 |