NPI | 1518959949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2002024941) |
Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MO 2002024941) |
Enumeration Date | 2005-08-22 |
Last Update Date | 2025-01-24 |