| NPI | 1023009321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 24954) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NC 24954) |
| 208600000X Surgery (Licence: NC 24954) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2018-10-23 |