NPI | 1497794119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA G27224) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA G27224) |
Enumeration Date | 2006-06-06 |
Last Update Date | 2017-11-16 |