| NPI | 1730377607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: MO 2023006574) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA MD.202374) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: LA pgy.1.lsuno-emr) | |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: MS 21347) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2023-06-05 |