NPI | 1871540716 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME96520) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME96520) |
Enumeration Date | 2006-05-27 |
Last Update Date | 2020-08-05 |