| NPI | 1003864521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2007-01496) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: SC 20361) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: NC 2007-01496) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-08-17 |