| NPI | 1669459657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101238611) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101238611) |
| 208D00000X General Practice (Licence: VA 0101238611) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2025-05-06 |