| NPI | 1235363433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: TX P2066) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P2066) |
| 208M00000X Hospitalist (Licence: TX P2066) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2019-04-26 |