| NPI | 1043390115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G12384) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA 00G12384) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2025-09-11 |