| NPI | 1497787873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX K7749) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K7749) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2012-01-25 |