| NPI | 1558527747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX N5867) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N5867) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2022-07-26 |