| NPI | 1821118506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: WI 62803) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 62803) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-11-23 |