| NPI | 1730316043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID O-0842) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 100581) |
| 207Q00000X Family Medicine (Licence: WI 66769-21) | |
| 207Q00000X Family Medicine (Licence: PA OS017304) | |
| 207Q00000X Family Medicine (Licence: IL 036 131300) | |
| 207Q00000X Family Medicine (Licence: AR E-7208) | |
| 207Q00000X Family Medicine (Licence: WI 66769) | |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: MT 100581) | |
| 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: ID O-0842) | |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2022-09-27 |