| NPI | 1205127982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: KS 04-36002) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KS 04-36002) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2022-09-27 |