| NPI | 1891003265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 5498540-1205) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: UT 5498540-1205) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2024-08-28 |