| NPI | 1902150535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: IA 24803) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA 24803) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2012-12-31 |