| NPI | 1497754428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NY 174130) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 174130) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2011-10-04 |