| NPI | 1861428633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: AZ 28468) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: AZ 28468) |
| 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: AZ 28468) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2010-04-22 |