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 |