| NPI | 1568417574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD24765) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: OR MD24765) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2021-02-11 |