| NPI | 1114119872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX M8435) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX M8435) |
| 208M00000X Hospitalist (Licence: TX M8435) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2022-07-19 |