| NPI | 1710957980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 7650579-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: NV 7979) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NV 7979) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 7650579-1205) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2011-01-27 |