| NPI | 1356607857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 23923) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME120700) |
| 208000000X Pediatrics (Licence: AL MD.34368) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MS 23923) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: AL MD.34368) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME120700) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2024-05-14 |