| NPI | 1770519191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TN 44134) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME90811) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TN 44134) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2017-07-26 |