| NPI | 1568773232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA OS018770) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: PA OS018770) |
| 208600000X Surgery (Licence: PA OS018770) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2018-12-31 |