| NPI | 1134362312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: CA A108019) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: CA A108019) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA A108019) | |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2015-08-30 |