| NPI | 1215914874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MN 59597) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MN 59597) |
| 207Q00000X Family Medicine (Licence: LA 025335) | |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2020-08-21 |