| NPI | 1811043201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: LA 023622) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 023622) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2009-07-28 |