| NPI | 1861474421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: IA DO-03231) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: IA 03231) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: IA 03231) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2023-03-07 |