| NPI | 1902875081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: VA 0101041389) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101041389) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2022-01-24 |