| NPI | 1063434801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NH 7821) |
| Additional Taxonomies | 208600000X Surgery (Licence: NH 7821) |
| 208600000X Surgery (Licence: TX L4133) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2015-11-30 |