| NPI | 1770892739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: FL ME114691) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: FL ME114691) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2024-02-22 |