| NPI | 1487796199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: OK 25082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OK 25082) |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: OK 25082) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2026-01-15 |