| NPI | 1447541941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: LA 303010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 281690) |
| 207Q00000X Family Medicine (Licence: LA 303010) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2022-08-10 |