| NPI | 1124123740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 86485) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 026644) |
| 207V00000X Obstetrics & Gynecology (Licence: GA 26644) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: GA 26644) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2021-08-24 |