| NPI | 1821073719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: FL OS15559) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL OS15559) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2024-12-18 |