| NPI | 1457442394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA A35154) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A35154) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2019-06-18 |