| NPI | 1720169576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 200201612) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35082668) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: OH 35082668) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2024-02-23 |