| NPI | 1376283754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TN 7103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 7103) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-08-06 |