NPI | 1639286172 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MD H67408) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD H0067408) |
Enumeration Date | 2006-08-23 |
Last Update Date | 2019-07-30 |