| NPI | 1649258971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX N8691) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: OH 34-00-3980- m) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX N8691) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2018-10-31 |