| NPI | 1346495678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 7471604-1204) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 7471604-1204) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2026-01-20 |