| NPI | 1336132158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: GA 39753) |
| Additional Taxonomies | 2086S0129X (Licence: GA 039753) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2026-01-26 |