| NPI | 1578594040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX N4376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036091654) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-07-30 |