| NPI | 1780621375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 25420) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: AZ 25420) |
| 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: AZ 25420) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2010-07-19 |