| NPI | 1780671453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 4750247-1204) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: CA 20A 6044) |
| 207Q00000X Family Medicine (Licence: UT 4750247-1204) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: UT 4750247-1204) | |
| Enumeration Date | 2005-09-28 |
| Last Update Date | 2011-09-22 |