| NPI | 1790868487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CT 030371) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 030371) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: CT 030371) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2017-03-07 |