| NPI | 1518071539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX D1836) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX D1836) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2010-12-02 |