| NPI | 1629040837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101249846) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: WA MD61453236) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2025-06-30 |