| NPI | 1629182647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: TX J1404) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX J1404) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2019-09-09 |