| NPI | 1871572123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX L 0036) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX L0036) |
| Enumeration Date | 2006-01-14 |
| Last Update Date | 2022-07-21 |