NPI | 1205813011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 33111) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 33111) |
Enumeration Date | 2005-12-22 |
Last Update Date | 2022-04-19 |