| NPI | 1780767616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL ME160203) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME160203) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2024-12-20 |