| NPI | 1629264007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: FL ME110989) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME110989) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2015-07-11 |