| NPI | 1710055140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CO 45929) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL FLME0035746) |
| 207Q00000X Family Medicine (Licence: FL FLME0035746) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2010-08-11 |