| NPI | 1982701769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: NC 2006001917) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NC 2006-00917) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NC 2006-00917) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-01-17 |