| NPI | 1003998071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: TX F8504) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX F8504) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX F8504) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2015-07-16 |