| NPI | 1407963705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MO R5211) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO R5211) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2012-05-30 |