| NPI | 1497915227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2009-01416) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 154668) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NC 154668) | |
| 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NC 154668) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2024-03-08 |