| 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 |