| NPI | 1417512872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: HI DOS-2117) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 390200000X) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2022-04-25 |