| NPI | 1467679134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: KS 0432710) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO R8E47) |
| 207P00000X Emergency Medicine (Licence: KS 0432710) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2010-12-15 |