| NPI | 1053318311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX H6484) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H6484) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2019-04-10 |