| NPI | 1942284310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 9700554) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 97-00554) |
| 207PE0005X Emergency Medicine Undersea and Hyperbaric Medicine (Licence: NC 97-00554) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2023-07-07 |