| NPI | 1366702813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: UT 10400109-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2015021873) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2021-04-23 |