NPI | 1013958644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MS 17316) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 17316) |
Enumeration Date | 2006-06-08 |
Last Update Date | 2022-02-03 |