| NPI | 1295737575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: FL ME43575) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME43575) |
| 207P00000X Emergency Medicine (Licence: FL ME43575) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2025-09-11 |