| NPI | 1801864566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101043800) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0101043800) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101043800) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2019-01-11 |