| NPI | 1740501717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NE 26583) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 26583) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 26583) | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2026-06-23 |