| NPI | 1538175443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX L1419) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L1419) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-04-03 |