| NPI | 1609832641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: LA MD.08818R) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: LA MD08818R) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-04-11 |