| NPI | 1730377607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: MO 2023006574) |
| Additional Taxonomies | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: MS 21347) |
| 207P00000X Emergency Medicine (Licence: LA MD.202374) | |
| 207PE0004X Emergency Medicine Emergency Medical Services (Licence: LA PGY.1.LSUNO-EMR) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2024-06-25 |