| NPI | 1487603312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: AZ 31568) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 31568) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2024-07-24 |