| NPI | 1225093222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 32818) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: KY 32818) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-05-11 |