| NPI | 1619084068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX J0487) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY TP280) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-07-11 |