| NPI | 1740253251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: VA 0101233862) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101233862) |
| 208600000X Surgery (Licence: VA 0101233862) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2019-01-03 |