| NPI | 1497759138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 30409) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: KY 30409) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2011-11-01 |