| NPI | 1285112672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 81808-20) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME167514) |
| 208D00000X General Practice (Licence: PR 15649) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2026-02-05 |