| NPI | 1760446561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: TX K0400) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX K0400) |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: TX K0400) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2008-01-23 |