| NPI | 1326148586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX K2933) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX K2933) |
| 207Q00000X Family Medicine (Licence: TX K2933) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-06-30 |