| NPI | 1730147471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9400204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9400204) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NC 9400204) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2022-01-15 |