| NPI | 1700862505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 29361) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CO 29361) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2007-07-08 |