| NPI | 1497073084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A127250) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME 105695) |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: FL ME105695) | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2016-09-28 |