| NPI | 1538168075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL 0029049) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME29049) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2019-09-24 |