| NPI | 1235196486 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301075147) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MI 4301075147) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2023-09-29 |