| NPI | 1336145390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX D3282) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX D3282) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2016-06-14 |