| NPI | 1649352451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: WV 18262) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WV 18262) |
| 208000000X Pediatrics (Licence: WV 18262) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-04-08 |