| NPI | 1033277876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: TX M2364) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M2364) |
| 2083A0100X Preventive Medicine Aerospace Medicine (Licence: TX M2364) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2024-01-25 |