| NPI | 1730158957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: UT 149717-1205) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: UT 182343-1205) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 182343-1205) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2010-04-15 |