| NPI | 1962585042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 028148) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: CT 028148) |
| 207P00000X Emergency Medicine (Licence: CT 028148) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-02-16 |