| NPI | 1841233608 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: LA 12523R)  | 
| Additional Taxonomies | 208600000X Surgery (Licence: LA 12523R)  | 
| Enumeration Date | 2006-06-13 | 
| Last Update Date | 2010-10-27 |