| NPI | 1619066693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: CA 20A9888) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AZ 4349) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2009-02-03 |