| NPI | 1811092935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WA MD00040277) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 87728) |
| 207Q00000X Family Medicine (Licence: NC 2010-01942) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-09-02 |