| NPI | 1447296298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 3144) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI E07166) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: AZ 3144) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-09-09 |