| NPI | 1336298496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX e0920) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX E0920) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-05-14 |