| NPI | 1558633826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: SC 95704) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 95704) |
| 225X00000X Occupational Therapist (Licence: SC 3864) | |
| Enumeration Date | 2012-02-02 |
| Last Update Date | 2026-04-07 |