| NPI | 1912923814 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: MI 5101013017) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101013017) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MI 5101013017) | |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MI 5101013017) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2020-02-10 |