| NPI | 1629010202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3836) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: AZ 3836) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: AZ 3836) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-05-13 |