| NPI | 1184699472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MI 5101011763) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03087) |
| 207Q00000X Family Medicine (Licence: WI 57339) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 57339) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2024-10-30 |