| NPI | 1841358769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 49914-020) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: WI 49914-020) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2015-06-26 |