| NPI | 1649558396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 26980) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 26980) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NE 26980) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2025-08-29 |