| NPI | 1568952869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS16903) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: FL OS16903) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-03-18 |