| NPI | 1861873762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NH 19658) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NH 19658) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2021-09-15 |