| 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 |