| NPI | 1962072991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME174678) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME174678) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 33993) | |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2025-06-10 |