| NPI | 1780639385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OR MD21966) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: OR MD21966) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2009-11-30 |