| NPI | 1114955812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX M7588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M7588) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2021-04-07 |