NPI | 1184699472 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 57339) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 03087) |
207Q00000X Family Medicine (Licence: WI 57339) | |
Enumeration Date | 2006-02-21 |
Last Update Date | 2019-11-21 |