| NPI | 1487823506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 203457) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: LA 203457) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: LA 203457) | |
| 208M00000X Hospitalist (Licence: WV 23274) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2020-04-15 |