| NPI | 1225248123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NH 15004) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NH 15004) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: NH 15004) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2017-05-19 |