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 |