| NPI | 1467436691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MO 115966) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KS 530128) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: OR DO28622) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2009-11-30 |