| NPI | 1821184482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F-6394) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: TX F-6394) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: TX F-6394) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-09-11 |